Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Aug 2017
Review"Ethics surrounding the provision of abortion care".
The provision of abortion care represents a great ethical challenge to physicians, particularly in countries where the law states that abortion is a crime. The concept that it is a crime carries a stigma that is worse than that associated with other acts qualified by law as crimes. ⋯ Both unethical behaviors may be associated with severe consequences for the health of women whose care was refused or delayed. Less attention is given to the ethical obligation to prevent induced abortion from recurring by offering postabortion contraception to comply with the ethical obligation of preventing harm to the patients for whose care they are responsible.
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In prenatal diagnosis, chromosomal microarray (CMA) has not yet fully replaced conventional karyotyping but has rapidly become the recommended test in pregnancies with ultrasound abnormalities. In this review, we provide an overview of the published data concerning this technology and the controversies concerning its use in the prenatal setting. ⋯ However, it has been shown that pregnant couples tend to prefer a maximum of information about the health of their unborn child. Taken together, CMA has considerable diagnostic and prognostic values during pregnancy and should therefore be the test of choice.
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Best Pract Res Clin Obstet Gynaecol · Oct 2016
ReviewAccountability for improving maternal and newborn health.
In 2010, the United Nations (UN) launched the Global Strategy for Women's and Children's Health to accelerate progress on maternal and child health. A UN Commission on Information and Accountability, established to ensure oversight and accountability on women's and children's health, outlined a framework with three processes: monitor, review, and act. This paper assesses progress on these processes. ⋯ Strategies are underway to improve accountability for severe maternal morbidity and perinatal mortality. The post-2015 agenda adds greater focus on reducing inequalities, increasing availability of quality, disaggregated data, and accountability for human rights. This agenda requires engagement with communities and health providers - the foundation of accountability for women's and children's health.
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Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. ⋯ Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.
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Best Pract Res Clin Obstet Gynaecol · May 2016
ReviewBreast cancer in pregnancy: A brief clinical review.
As global wealth increases and demographic changes similar to Europe and North America start affecting other societies, the global breast cancer epidemic will coincide with a delayed maternal age during first and subsequent pregnancies. Breast cancer in pregnancy will continue to increase, and standardized treatment strategies are required to be developed. This study will review current diagnostic and treatment approaches.